Facility Evaluation Report

Licensing Program Analyst (LPA) Araceli Canela arrived for the purpose of conducting a 1 year inspection and met with licensee Mary Grace Dairo. This facility has a total of 3 bedrooms that will be used by residents, 1 staff office/bedroom, 2 bathrooms, living room, dinning room, kitchen and garage. Backyard has a shed that is used for storage and locked. Licensee will ensure sufficient staffing at all times. Facility understands, they do not have approval for locked perimeter.

This visit was scheduled with licensee because the facility doe snot have any residents at this time. This facility is licensed for 4 non-ambulatory, 2 ambulatory residents with a total capacity of 6.

· 7 smoke detectors and 2 carbon monoxide detector.

. Water temperature was between 105-120 degrees F.

· Supply of linens, paper products, and hygiene supplies available

· Required furnishings in 3 of 3 resident bedrooms.

. There was plenty of emergency food and water along with emergency backpacks.

The facility currently has no residents and there were no records to review.

LPA requested the following forms to be sent to LPA by 10/12/2024 :

No deficiencies issued during todays inspection.